Basic Information
| Provider Information | |||||||||
| NPI: | 1689914863 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RHODES | ||||||||
| FirstName: | REBECCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5225 S LOOP 289 STE 210 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794241319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067804180 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5225 S LOOP 289 STE 210 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794241319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067804180 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2013 | ||||||||
| LastUpdateDate: | 05/12/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1179650 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 331042299 | 05 | TX | MEDICAID |